|
BCR/ABL Nucleic Acid Probe
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
2790801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$15.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$32.40
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
BCR/ABL Nucleic Acid Probe
|
Facility
IP
|
$54.00
|
|
| Hospital Charge Code |
2790801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
BCR/ABL Reverse Transcription
|
Professional
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
BCR/ABL Reverse Transcription
|
Facility
OP
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
BCR/ABL Reverse Transcription
|
Facility
IP
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
BD Bone Density DEXA App Skeleton
|
Facility
OP
|
$475.00
|
|
|
Service Code
|
CPT 77081 TC
|
| Hospital Charge Code |
1178799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Aetna Managed Medicare |
$133.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$285.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$308.75
|
| Rate for Payer: Quartz Medicare Advantage |
$285.00
|
| Rate for Payer: The Alliance Commercial |
$1,900.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
BD Bone Density DEXA App Skeleton
|
Facility
IP
|
$475.00
|
|
|
Service Code
|
CPT 77081 TC
|
| Hospital Charge Code |
1178799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$285.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$285.00
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
BD Bone Density DEXA App Skeleton
|
Professional
|
$475.00
|
|
|
Service Code
|
CPT 77081 TC
|
| Hospital Charge Code |
1178799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Aetna Managed Medicare |
$20.71
|
| Rate for Payer: Anthem Medicare Advantage |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.71
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.71
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.71
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: Quartz Medicare Advantage |
$20.71
|
| Rate for Payer: The Alliance Commercial |
$78.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.71
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$103.55
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
IP
|
$732.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
611590
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
OP
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.12 |
| Max. Negotiated Rate |
$2,916.00 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Aetna Managed Medicare |
$204.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.75
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$473.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.40
|
| Rate for Payer: The Alliance Commercial |
$2,916.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
IP
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.21 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$437.40
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Professional
|
$732.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
611590
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna Commercial |
$695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Aetna Managed Medicare |
$36.61
|
| Rate for Payer: Anthem Medicare Advantage |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.61
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$695.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.61
|
| Rate for Payer: Health EOS Commercial |
$666.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.61
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$695.40
|
| Rate for Payer: Quartz Beloit One Network |
$322.08
|
| Rate for Payer: Quartz Commercial |
$417.24
|
| Rate for Payer: Quartz Medicare Advantage |
$36.61
|
| Rate for Payer: The Alliance Commercial |
$139.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.61
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$183.05
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Facility
OP
|
$732.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
611590
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$9,342.88 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.36
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$9,342.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
BD Bone Density DEXA Axial Skeleton
|
Professional
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna Commercial |
$692.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Aetna Managed Medicare |
$27.47
|
| Rate for Payer: Anthem Medicare Advantage |
$27.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.47
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$692.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.47
|
| Rate for Payer: Health EOS Commercial |
$663.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.47
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$692.55
|
| Rate for Payer: Quartz Beloit One Network |
$320.76
|
| Rate for Payer: Quartz Commercial |
$415.53
|
| Rate for Payer: Quartz Medicare Advantage |
$27.47
|
| Rate for Payer: The Alliance Commercial |
$104.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.47
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$137.35
|
|
|
BD Bone Density DEXA Body Composition
|
Professional
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.47 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna Commercial |
$692.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Aetna Managed Medicare |
$27.47
|
| Rate for Payer: Anthem Medicare Advantage |
$27.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.47
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$692.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.47
|
| Rate for Payer: Health EOS Commercial |
$663.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.47
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$692.55
|
| Rate for Payer: Quartz Beloit One Network |
$320.76
|
| Rate for Payer: Quartz Commercial |
$415.53
|
| Rate for Payer: Quartz Medicare Advantage |
$27.47
|
| Rate for Payer: The Alliance Commercial |
$104.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.47
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$137.35
|
|
|
BD Bone Density DEXA Body Composition
|
Facility
IP
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$357.21 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$437.40
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
BD Bone Density DEXA Body Composition
|
Facility
OP
|
$729.00
|
|
|
Service Code
|
CPT 77080 TC
|
| Hospital Charge Code |
1178803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$204.12 |
| Max. Negotiated Rate |
$2,916.00 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Aetna Managed Medicare |
$204.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.75
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$473.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.40
|
| Rate for Payer: The Alliance Commercial |
$2,916.00
|
| Rate for Payer: United Healthcare PPO |
$546.75
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
IP
|
$435.00
|
|
| Hospital Charge Code |
675633
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BD Bone Density Vetebral Fracture
|
Professional
|
$452.00
|
|
|
Service Code
|
CPT 77086 TC
|
| Hospital Charge Code |
1178805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Aetna Commercial |
$429.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$23.93
|
| Rate for Payer: Anthem Medicare Advantage |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.93
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$429.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.93
|
| Rate for Payer: Health EOS Commercial |
$411.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.93
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$429.40
|
| Rate for Payer: Quartz Beloit One Network |
$198.88
|
| Rate for Payer: Quartz Commercial |
$257.64
|
| Rate for Payer: Quartz Medicare Advantage |
$23.93
|
| Rate for Payer: The Alliance Commercial |
$90.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.93
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$119.65
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
OP
|
$452.00
|
|
|
Service Code
|
CPT 77086 TC
|
| Hospital Charge Code |
1178805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$126.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$271.20
|
| Rate for Payer: The Alliance Commercial |
$1,808.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
OP
|
$435.00
|
|
| Hospital Charge Code |
675633
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$121.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$261.00
|
| Rate for Payer: The Alliance Commercial |
$1,740.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BD Bone Density Vetebral Fracture
|
Professional
|
$435.00
|
|
| Hospital Charge Code |
675633
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BD Bone Density Vetebral Fracture
|
Facility
IP
|
$452.00
|
|
|
Service Code
|
CPT 77086 TC
|
| Hospital Charge Code |
1178805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
BEADED WIRE 16GA SIZE 10 1191-048
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
BEADED WIRE 16GA SIZE 10 1191-048
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$52.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
